I had been agitating for several years about the harassment of women in surgical training and came to the attention of Diann Rodgers Healey, a remarkable woman and the director of an organisation called the Australian Centre for Leadership for Women. She was putting together an ebook entitled Pathways to gender equality in Australia: the role of merit and quotas and she asked me to write the chapter on medicine. There are chapters on other professions and it is striking how similar the issues are in all of them. Sexual harassment is a depressingly common theme.

The book launch was held at NSW Parliament House in March 2015 on the day before International Women’s Day and I was asked to give the final speech. I was then interviewed by a junior reporter from ABC Radio who asked, incredulously, if there really was sexual harassment in surgery.

To date only 56% of surgeons in NSW have complied. There are undoubtedly those who feel that it is beneath them and it is quite likely that those who most need to examine their own behaviour are among these. Many of those who have complied are very critical of the module and consider it a waste of time – just another of the “tick box” pro formas that we are bombarded with. It is unclear what will happen to those who refuse to comply, and it seems highly unlikely that Fellowships will be withdrawn. It is a futile exercise.

Every operating theatre in Australia now boasts an Operating with respect poster proclaiming that bullying will not be tolerated and yet I continue to receive letters, emails and phone calls on a regular basis with complaints, not only from surgical trainees but trainees in all medical specialties, and also from nursing staff. When I suggest the complaints process I am met with fear of reprisal. There has, after all, been no feedback from the RACS regarding the outcome of complaints.

I was recently asked to give the keynote address at a hospital in Sydney for their inaugural “Women in medicine” meeting. It was well attended by junior staff, both male and female, and there was an impressive panel of senior women. I had advised that women should now take a zero-tolerance approach to harassment but when a young woman asked the panel what she should do if targeted they all advised against a formal complaint and suggested that she seek out a senior woman for help.

A nurse who complained that a surgeon had shouted and physically barged her during an operation told me that she had received little support and indeed had been criticised for her own behaviour (victim blaming).

Similarly, a female surgical trainee was referred to me for help by a male colleague. She recounted how a more senior trainee was trying to sabotage her career by blaming her for his mistakes in the operating theatre. As a result, she was gaining the reputation for being incompetent, something that often happens to women, and was being required to undergo a review process. He then compounded the issue by “nudging” her arm during an operation, causing her to lacerate the liver. This appalling behaviour and the implications for the patient have never been addressed by the hospital despite her report on the event.

Realistically, the only effective means of resolving this “he said, she said” situation would be for CCTV monitoring of behaviour in the operating theatre – the “black box”.

It is already available and was created in 2013 by Dr Teodor Grantcharov in Toronto, Canada. It consists of two cameras recording the operating team and their interactions and, in addition, the vital signs of the patient are recorded. When a camera is being used inside the body, as with laparoscopic procedures, this footage is also recorded. The aim is to improve safety for the patient by showing where mistakes are made and how a surgeon can improve technically, but it has also shown how communication between the operating team affects outcomes.

This would not, of course, help the many interactions that occur outside the operating theatre. It would not help the trainee who was drugged and sexually assaulted by the revered oncologist, John Kearsley, who invited her to his home to discuss her career. As with Weinstein, this was not an isolated incident but part of a pattern of behaviour. He was a predator taking advantage of his power in a hierarchical profession. I am still astounded by the number of men who express support for him and blame the victim for being stupid. It is also clear that there is willing blindness by those around these men that allows the behaviour to persist, presumably afraid for their own positions if they were to tell.

The last 3 years have taught me that the world is uglier than I had thought. I have been astounded by the stories I have heard and dismayed by the impossibility of redress for the victims or consequences for the perpetrators. I have learnt a great deal more about unconscious bias and how insidious a problem it is for women. I have learnt that there is little transparency and a great deal of secrecy. My “invisibility cloak” is useful in making people feel safer to approach me for help and I continue to do this to the best of my ability.

My advice to young women is to always have their recording device (phone) at the ready. The Channel 7 cadet who complained about sexual harassment and was subsequently fired after being falsely accused of bullying was only vindicated because she recorded the termination interview. She received a monetary payout but the career that she had worked so hard for was taken away from her and we have to conclude that she probably would have been more successful if she had complied with the sexual advances.

It has been almost 3 years since I made my infamous “blow job” comment. Nothing much has changed, it seems.

Dr Gabrielle McMullin is a consultant vascular surgeon at St George and Sutherland Hospitals, Sydney.

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30 thoughts on “Sexual harassment: time for a “black box”?”

I have not suffered any sexual harrassment recently. I believe I am quite lucky but I have always made it clear to all junior staff that they are allowed to contact me if it does occur to them and I will deal with it.

This is part of a larger problem. Where do junior doctors go when they are under stress? In addition to the abhorrent acts of sexual harassment and their consequences, trainee doctors are and always have been subject to major stress for which they have little or no training. There has been a terrible incidence of suicide amongst trainees at all levels, and it seems that they have little idea of where they can receive help, support and counselling.
Trainees who feel bullied, harassed or under stress should have available to them a body that can support their need for help, but which does not in any way threaten their career pathway. Clearly, this needs to be independent of the colleges, and probably also of the hospital administration, although the administration should get (unidentified) reports from this body that keeps them up to date about these aspects of the hospital they administer

Women have an ability to behave asexually and professionally that most men just seem to lack. I suppose you could blame it on hormones or some such thing. How many of us, as we prpgressed through our training were not exposed to some sort of unwanted sexual advance.

I know one female colleague who was all but raped by akre senior trainee at a house party, and hasn’t been free to talk about it.

There is a reason that women are better clincians, they have an ability to stay clear headed at work and at home.

Thank you for your ongoing and courageous work in this area. With the evidence showing training sessions do not achieve change in these types of behaviour the need for a range of structural and cultural changes over the long term will be required.

Your post has been helpful, and I congratulate you on the work that you are doing. It is such a shame that (so far as surgery goes), the vast majority of those in leadership positions are men. That has not been healthy, and I think structural change is really required. Men in power cannot be trusted.

This needs to be an integral part of training for both sexes – men are often poor at reading the signs, mistaking silence for consent or even encouragement. Case-based discussion can help to clarify situations in which the line is crossed, but it’s much more complex than a simple male perpetrator/female victim dichotomy, or any other black/white distinction.

Couldn’t have worded it better Jennifer! I think the same mindset that enables ‘misreading consent’ is not helpful in many leadership roles. I think your comment Marcus that men should “stand aside” is a bit much, but definitely there needs to be a development of women’s leadership roles, and equality numerically.
To return to the topic, I have had my share of misogynistic men block my progression in my medical (not surgical specialty) just because I am female. But they don’t ever stop to think twice about making sexual advances towards me constantly; yes – the same men.
It will be a much better world when there are less men in leadership. It is innate in men to be selfish, something like original sin.

As a man I have not suffered the sexual harassment as experienced by all too many women.
I have however, seen and suffered harassment for other reasons and that can be no less harmful, belittling and destructive as sexual harassment (as opposed of course to the crime of physical/sexual assault)
A number of points.
1) I have however, experienced the confusion that comes from NOT paying enough attention to giving adequate attention to understanding the way that the flirting game is an essential part of getting along with many members of the nursing sister and brotherhood.
It has only come to me belatedly that if I had played along a bit more with some who clearly were playing this game, then my career experiences would have been different.
This is an aspect of practice that is never spoken of but when I raise this issue, without fail the response is “Yes…, that is absolutely right. That is exactly what is going on.”
2) We all know of situations where this is taken to the extreme, either as a policy within departments full of thrusting, snorting alpha males going after the hottest intern, dangling the prospect of a good job as the bait.

3) On the wards where there is almost always (used to be?) a louche Lothario with (astoundingly) a ready string of aptly named ‘hook ups’ to sate the Satyrical libido.

None of us would really want to identify with the behaviour at 2) and various colleges should by now be on the look out for it and come down very hard when it is found and or notified.
For most of us, the line between the behaviour at 1) and 3) is somewhat hard to discern, being dependent upon so many subjective factors, but it can be the different between being seen as ‘a spunk’ or a ‘sleaze’..

Finally and this is something that is hardly ever discussed, one person’s “sexual harassment” (a humorous comment between two adjacent adults can qualify? Really??) is another persons funny joke.
A hand on a shoulder? No kindly, caring gestures now??
What if the recipient is the same sex? Physical or sexual assault depending upon their proclivities, or even both??

As I read it, changes to 18c were rejected on the grounds that “being offended” and “taking offense” is a very subjective “thin edge of the wedge” matter, given how variable people’s responses and sensibilities are, despite the faux outrage some vested interests express.
Feeling “sexually harassed” by an overheard casual comment should fall into the same category and should not be allowed as yet another weapon in the arsenal of the largely self appointed expert self righteous who tell all others how they MUST behave.

No Jennifer, in the fact the point is that it is not about “men” and “women” (or “Men” and “Women”), but about some reprehensible men (and a reprehensible occasional woman) who have used their positions of power in an attempt to coerce sexual favours; some men (and some women) who are just doofuses and social misfits who don’t recognise the boundaries of appropriate behaviour; some poor unfortunates, who – like most of the world in the past – see the workplace as one of the venues where one might meet a potential partner, but who do not have their interest reciprocated; and then a whole bunch of men and women who just come to work, do their job – would never dream of harassing or propositioning anybody – and then go home again.
The last group does not need any training.
Men = Evil; Women = Victim is indeed not an adequate distillation of the problem.

1. Not all men are predators and it is not only women who are sexually harrassed. So please don’t attach attribute negative characteristic to a group of people based based upon their gender. It isn’t acceptable to do the same about homosexuals, aboriginals, jews, muslims etc.. So it shouldn’t be acceptable to do it about men or women.

2. “He then compounded the issue by “nudging” her arm during an operation, causing her to lacerate the liver.” Really? This animal must be reported – immediately. Otherwise you are just like the Catholic Church – hiding its paedophiles.

Any doctor or medical student who comes to our (senior doctors’) notice as suffering psychologically from bullying or sexual harassment should be directed to the Victorian Doctors’ Health Program. I presume other states have similar services.
Other than calling out this appalling behaviour if I become aware of it, I’m not sure I can readily change entrenched behaviours. However what we can and should do is to get alongside the victims and guide them to supportive assistance before irreparable damage is done.

Having worked in the hospital environment for many years what is clear to me is that poor behaviour is pervasive and its protagonists derive from both sexes, many professions, different ages, varying status, colour, creed etc etc.

Untrue baseless sweeping alarmist rhetoric against groups (‘men’, ‘surgeons’, etc) is exactly part of the very behaviour that needs to be eradicated, and is unfortunately all too evident in this series of comments

Last time I checked the serial perpetrators were a varied mix – today it was a senior female nurse, male orderly, senior female anaesthetist, male surgical registrar etc.

Let us focus on the behaviour and what is really important – being good people to all – meaning each other and the patients – all of the time, and trying to constantly be better.

I find it interesting that the author in the first paragraph conflates sexual abuse with gender equality, and I think this really brings out the reality of the fact that there is no such thing as ‘gender equality.’ Men are simply different beings to women. Men are generally more brash and rough, and occasionally there are sour grapes that abuse women. Women are generally more emotional and dare I say moody, and occasionally there are sour grapes that manipulate and ‘victim play’ over men. That’s been the reality for as far back as man existed, and it isn’t likely to change, no matter what policy or black box you throw at it, a way will be found around it. Do you think an abusive surgeon who knows there is a black box won’t abuse outside the operating theatre instead? I am not justifying the behaviour, I am just pointing it out.

I can attest to the fact that several midwifery units in the state of Victoria (I can only speak of that) are run by female characters that quite frequently put patient safety last in pursuit of their own selfish agenda, manipulate, file useless and unfair complaint to achieve their ends etc. I never hear of black boxes for that. I think the reason is that men generally have learnt to accept the gender differences, and are not attempting to ‘equate’ anything that doesn’t add up.

I agree with senior white male surgeon that poor behaviour is common among human beings and not limited to white male surgeons or to sexual harassment. I have on occasions perceived that I have been bullied by female admin staff and nursing staff and have also been subjected to racial slurs from patients. I have seen poorly performing junior staff alleging that they are being bullied when they have only been told that their work is not up to standard. Let us not get into this blame game or join the never ending groups of “victims”. We need to call out bullying when we observe such behaviours and stand up for yourselves.

One might object to a black box on grounds of intrusion and privacy issues, but we seem increasingly to accord these less value as we accept surveillance to protect us, for example, from terrorism.
We do know, however, that the greatest rates of sexual harassment and indeed violence against women occur in the domestic environment, so that achieving the greatest yield for our resources might suggest that a black box in the home could be best, probably in the bedroom.

Dear 3. Anonymous,
There are doctors health programs available in every state to support all doctors and medical students. This is an invaluable resource for junior doctors under stress. These programs operate independently and are confidential. They can provide support, help and counselling when you need it.
For those wishing to take action there are a number of options and the AMA is a good starting point for advice about the best course to take according to your individual situation.

I think the fact that most of the excuses for bad behaviour and victim blaming in the comments on this article come from my fellow male doctors speaks for itself.

While sexual harassment and sexual assault in the healthcare workplace may be perpetrated by a minority of men (and women), it seems there are no shortage of enablers of bad behaviour, bullies and people willing to silence victims in senior positions.

We know from the extensive literature that both men and women perpetrate abuse and both men and women can be victims. However due to ongoing sexism and the fact that more men than women are in senior medical positions (and more women in junior medical positions), men are more likely to be perpetrators, women are more likely to be victims and importantly women are more likely to suffer serious consequences psychologically and to their careers than men. There is a large body of evidence to support this, including from national statistics.

It’s sad to see that a very similar narrative to the national domestic violence and sexual assault story is playing out within what is meant to be a healing profession.

Every woman I know in medicine has a story about grossly inappropriate sexual behaviour in the workplace.

This needs to stop. Our profession needs to be just as accountable as any other profession.

In addition the focus needs to move away from “victim resilience” to addressing systemic issues in the workplace, rehabilitating offenders who are capable of reform and therapy, and removing from the workplace those who are recurrent, unrepentant and/or dangerous.

This is what is best practice is in other professions. This is how broader society has tackled other issues to do with sexual crime and sexism.

In an era where the role of systemic workplace dysfunction in healthcare worker mental health is under scrutiny for good reason – doctors’ suicides in particular – having an issue like this unaddressed is just asking for trouble.

May I ask a question to all those who have commented. Why is sexual abuse (I mean not in its more gross forms) any worse than a multitude of other behaviours? Why is the focus always on sexual ‘abuse,’ which can mean anything from inappropriate looking to rape? There are 1,000 behaviours that are wrong with both men and women, but this one is the one in the limelight constantly at present. I suggest everyone needs a scapegoat…

Time magazine has chosen “The Silence Breakers” as person of the year and I suggest that many of those making comments here read it as it powerfully explains why sexual harassment is such an important issue.

I was a former RACS trainee. The sexual harassment and bullying I experienced led to my decision to leave the profession. I believe the only way to stop this behaviour is to hit the surgeons where it hurts the most- their wallet. Slogans on posters and learning modules are useless. Remove their public hospital posting if they have enough complaints against them. Make it compulsory for trainees to provide feedback about their supervisors. Make an example of certain individuals who are known for their behaviour so others will not fear coming forward.